Longitudinal Changes in Size of Conservatively Managed Flow-Related Aneurysms Associated with Brain Arteriovenous Malformations
| Autor: | Zack Millar, Midhun Mohan, Tamara Tajsic, Jennifer J.L. Cao, Ramez W. Kirollos, Karol P. Budohoski, Mathew R. Guilfoyle, Tanmay Sukthankar, Rikin A. Trivedi, Saniya Mediratta, Ellie Phelps, Damiano G. Barone, Adel Helmy |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_specialty Tailored approach Conservative management Subgroup analysis Conservative Treatment Culprit medicine Humans Longitudinal Studies Hemodynamic stress Aged Retrospective Studies medicine.diagnostic_test business.industry Endovascular Procedures Arteriovenous malformation Intracranial Aneurysm Middle Aged medicine.disease Treatment Outcome Angiography Surgery Female Neurology (clinical) Radiology business Background flow |
| Zdroj: | World neurosurgery. 154 |
| ISSN: | 1878-8769 |
| Popis: | Background Flow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after successful AVM treatment. Methods Patients with symptomatic AVMs and associated FAs who underwent successful treatment of the AVM between 2008 and 2017 were included. FA dimensions were measured on surveillance angiography to assess longitudinal changes. Results Thirty-two patients were identified with 48 FAs. Sixteen (33%) FAs were treated endovascularly; 18 (38%) FAs were treated surgically; and 14 (29%) FAs (11 patients) were monitored. FAs demonstrated a decrease in size from 5.0 mm to 3.8 mm (24%; P = 0.016) and 4.9 mm to 3.6 mm (27%; P = 0.013) in height and width, respectively, over a median 35 months. However, on subgroup analysis, only class IIb aneurysms demonstrated a significant decrease in size (51% reduction in largest diameter, P = 0.046) and only 3 FAs (21%) resolved. There were no hemorrhages observed during follow-up. Conclusions While conservatively managed FAs demonstrated a reduction in size after the culprit AVM was treated, this was only significant in FAs located close to an AVM nidus (class IIb). There were no hemorrhages during the median 35 months’ follow-up; however, long-term data are lacking. Our data support close observation of all conservatively managed aneurysms and a tailored approach based on the proximity to the nidus and observed changes in size. |
| Databáze: | OpenAIRE |
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